HIV/AIDS Subpopulation
Value Based Payment Quality Measure Set
Measurement Year 2022
- Measure Set is also available in Portable Document Format (PDF)
December 31, 2021 NYS Medicaid Value Based Payment
INTRODUCTION
The Measurement Year (MY) 2022 People Living with HIV/AIDS (HIV/AIDs) Quality Measure Set was created in collaboration with the People Living with HIV/AIDS Quality of Care Clinical Advisory Committee (QAC), the Primary Care (Physical Health), and the Behavioral Health/HARP Clinical Advisory Groups (CAGs), as well as the New York State Department of Health (NYS DOH) CAG Strategy team. The goal of this measure set is to align with measures put forth in the NYS Quality Assurance Reporting Requirements (QARR), the HEDIS®1 Technical Specifications for Health Plans, the CMS Core measure set, and the Merit-based Incentive Payment System (MIPS), where applicable. The measure set is designed to encourage providers to meet high standards of patient-centered clinical care and coordination across multiple care settings.
MEASURE SELECTION AND FEASIBILITY
During the spring and fall of 2021, the HIV/AIDs QAC reconvened and made recommendations to the State on quality measures, data collection, data reporting, and support required for providers to be successful in a VBP environment.
Upon receiving recommendations from the QAC & CAGs, the release of guidelines from national measure stewards, such as NCQA/HEDIS©,2 and in accordance with the NYS VBP Roadmap;3 the State defined a final list of measures to be included in the HIV/AIDs Measure Set for MY2022. For MY2022, thirty-four measures have remained unchanged, three measures were added by HEDIS, and three measures have been removed. This culminates in a total of thirty-seven Category 1 and 2 People Living with HIV/AIDS Quality Measures.
PROPOSED VBP ARRANGEMENT REQUIREMENTS FOR MY2023 - HEALTH EQUITY
For MY2022, NCQA is adding race and ethnicity stratification for five HEDIS measures to help promote transparency into health plan performance. By doing so, NCQA hopes to better identify where disparities exist, so they can be addressed. They also hope to identify and learn from top performers in areas where disparities don´t exist. To align with this initiative, NYS will require payers and providers to incorporate race and ethnicity measure stratification in Value Based Payment (VBP) arrangements starting in July 2022.
Stratification Specifications:
- Payers will be required to include at least one of the following measures in all level 1 or higher VBP arrangements and stratify results by race and ethnicity categories as outlined in the HEDIS MY2022 specifications.3 The table below depicts available quality measures by arrangement type.
| NQCA Measure Name | Measure Inclusion by Arrangement Type | |||||
|---|---|---|---|---|---|---|
| TCGP | IPC | HARP/BH | Maternity | HIV/AIDs | Children´s | |
| Colorectal Cancer Screening | ✓ | ✓ | ✓ | ✓ | ||
| Controlling High Blood Pressure | ✓ | ✓ | ✓ | ✓ | ||
| Hemoglobin A1c Control for Patients with Diabetes | ✓ | ✓ | ✓ | ✓ | ||
| Prenatal and Postpartum Care | ✓ | ✓ | ||||
| Child and Adolescent Well–Care Visits | ✓ | ✓ | ✓ | |||
- Stratification of selected measures will be classified as pay-for-reporting (P4R).
- Payers will be required to include the following detail in the Provider Contract Statement and Certification form and Contract language:
- Indicate what measure(s) will be included for race and ethnicity stratification.
- Indicate how the stratified measure results for applicable measures will be shared with the VBP contractor.
- Plans will be required to include the race and ethnicity data to NYS using the following method:
Race and ethnicity fields will be added to the annual VBP member attribution submission file specifications. This will allow the State to stratify measure performance by race and ethnicity categories for applicable performance measures at the VBP contract and VBP Contractor levels.
The DOH recognizes that MCOs and providers are in the process of negotiating VBP arrangements to meet Statewide VBP goals. Therefore, all new contracts submitted on or after July 1, 2022, must meet this requirement. All other existing contracts must be updated at the end of the contract´s current measurement period and before the contract´s next measurement period begins, or no later than April 1, 2023.
MEASURE CLASSIFICATION
Each measure has been designated by the State as Category 1, 2, or 3 with associated recommendations for implementation and testing for future use in VBP Arrangements. The measures below are classified by category based on an assessment of reliability, validity, and feasibility, and according to suggested method of use (either Pay for Reporting (P4R) or Pay for Performance (P4P)).
Categorizing and Prioritizing Quality Measures
CATEGORY 1
Approved quality measures that are deemed to be clinically relevant, reliable, valid, and feasible.
CATEGORY 2
Measures that are clinically relevant, valid, and reliable, but where the feasibility could be problematic. These measures were investigated during the 2017 & 2020 pilot programs.
CATEGORY 3
Measures that are insufficiently relevant, valid, reliable and/or feasible.
Category 1
Category 1 quality measures as identified by the CAGs and accepted and deemed reportable by the State are to be reported by VBP Contractors to the MCOs. These measures are also intended to be used to determine the amount of shared savings for which VBP contractors are eligible.4 At least one Category 1 P4P measure must be included in a VBP contract.
The State classified each Category 1 measure as either P4P or P4R:
- P4P measures are intended to be used in the determination of shared savings amounts for which VBP Contractors are eligible. Measures can be included in both the determination of the target budget and in the calculation of shared savings for VBP Contractors.
- P4R measures are intended to be used by the MCOs to incentivize VBP Contractors for reporting data to monitor quality of care delivered to members under the VBP contract. Incentives for reporting will be based on timeliness, accuracy, and completeness of data. Measures can be reclassified from P4R to P4P through annual CAG and State review or as determined by the MCO and VBP Contractor.
Not all Category 1 measures will be reportable for the measurement year, as reporting on some of these measures will be phased in over the next few years. Please refer to the Value Based Payment Reporting Requirements Technical Specifications Manual (MY2022) for details as to which measures must be reported for the measurement year. This manual will be updated annually each fall, in line with the release of the final VBP measure set for the subsequent year.
Categories 2 and 3
Category 2 measures have been accepted by the State based on the agreement of clinical importance, validity, and reliability, but flagged as presenting concerns regarding implementation feasibility. The State has discussed measure testing approaches, data collection, and reporting requirements with VBP CAGs.
Measures designated as Category 3 were identified as unfeasible at this time or as presenting additional concerns including accuracy or reliability when applied to the attributed member population for an arrangement, therefore Category 3 measures are not included in the measure set.
MY 2021 HIV/AIDS QUALITY MEASURE SET
The measures and State-determined classifications provided on the following pages are recommendations for MY2021. Note that measure classification is a State recommendation and implementation is to be determined between the MCO and VBP Contractor.
Measure sets and classifications are considered dynamic and will be reviewed annually. Updates will include measure additions, deletions, recategorizations, and/or reclassifications from P4R to P4P or vice versa, based on experience with measure implementation in the prior year. In 2021, the CAGs and the VBP Workgroup will re-evaluate measures and provide recommendations for MY2022. Please see Appendix A for a full list of these changes.
Category 1
The table below displays the Category 1 HIV/AIDS Quality Measure Set, arranged alphabetically, and includes measure title, measure steward, the National Quality Forum (NQF) number and/or another measure identifier (where applicable), and State-recommended classification for measure use. The measure set is redlined to highlight changes made between MY2020 and MY2021. Additions are marked by red text while deletions are marked by a red strikethrough.
| Measure | Measure Steward | Measure Identifier | Classification |
|---|---|---|---|
| Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder | Centers for Medicare & Medicaid Services (CMS) | NQF 1880 | P4P |
| Antidepressant Medication Management - Effective Acute Phase Treatment & Effective Continuation Phase Treatment | National Committee for Quality Assurance (NCQA) | NQF 0105 | P4P |
| Asthma Medication Ratio | NCQA | NQF 1800 | P4P |
| Breast Cancer Screening | NCQA | NQF 2372 | P4P |
| Cervical Cancer Screening | NCQA | NQF 0032 | P4P |
| Colorectal Cancer Screening** | NCQA | NQF 0034 | P4P |
| Controlling High Blood Pressure** | NCQA | NQF 0018 | P4P |
| Depression Remission or Response for Adolescents and Adults | NCQA | P4P | |
| Depression Screening and Follow-Up for Adolescents and Adults | NCQA | P4R | |
| Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications | NCQA | NQF 1932 | P4P |
| Eye Exam for Patients With Diabetes* | NCQA | NQF 55 | P4P |
| Hemoglobin A1c Control for Patients With Diabetes (HBD)** | NCQA | NQF 59 | P4P |
| HIV Viral Load Suppression | Health Resources and Services Adm (HRSA) | NQF 2082 | P4P |
| Initiation and Engagement of Substance Use Disorder Treatment* | NCQA | NQF 4 | P4P |
| Initiation of Pharmacotherapy upon New Episode of Opioid Dependence | NYS | - | P4P |
| Kidney Health Evaluation for Patients with Diabetes | NCQA | P4P | |
| Potentially Avoidable Complications in Patients with HIV/AIDS | Altarum Institute | - | P4R |
| Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan | CMS | NQF 0421 | P4R |
| Preventive Care and Screening: Influenza Immunization | American Medical Association Physician Consortium for Performance Improvement (AMA PCPI) | NQF 0041 | P4R |
| Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention | AMA PCPI | NQF 0028 | P4R |
| Sexually Transmitted Infections: Screening for Chlamydia, Gonorrhea, and Syphilis | NYS | - | P4R |
| Statin Therapy for Patients with Cardiovascular Disease | NCQA | - | P4R |
| Use of Pharmacotherapy for Alcohol Abuse or Dependence | NYS | - | P4R |
| Use of Spirometry Testing in the Assessment and Diagnosis of COPD | NCQA | NQF 0577 | P4R |
* Measure removed from HEDIS/NYS 2022 Measure Set
** Measure specifications/name revised by NCQA/NYS for 2022 HEDIS Measure set
** HEDIS Stratified Measure
Category 2
The table below displays the Category 2 People Living with HIV/AIDS Quality Measure Set and includes measure title, measure steward, and the NQF number (where applicable). All Category 2 measures are classified as P4R in MY2022. There are no CAT 2 changes between MY2021 and MY2022.
| Measure | Measure Steward | Measure Identifier |
|---|---|---|
| Asthma Action Plan | American Academy of Allergy, Asthma & Immunology (AAAAI) | - |
| Asthma: Assessment of Asthma Control – Ambulatory Care Setting | AAAAI | - |
| Asthma: Spirometry Evaluation | AAAAI | - |
| Continuing Engagement in Treatment Alcohol and Other Drug Dependence | NYS | - |
| Continuity of Care from Inpatient Detox to Lower Level of Care | NYS | - |
| Continuity of Care from Inpatient Rehabilitation for Alcohol and Other Drug Abuse or Dependence Treatment to Lower Level of Care | NYS | - |
| Diabetes Screening | NYS | - |
| Hepatitis C Screening | HRSA | - |
| Home Management Plan of Care (HMPC) Document Given to Patient/Caregiver (asthma) | TJC | NQF 338 |
| Housing Status | HRSA | - |
| Linkage to HIV Medical Care | NYS | - |
| Pharmacotherapy for Opioid Use Disorder | NCQA | NQF 3175 |
| Prescription of HIV Antiretroviral Therapy | HRSA | NQF 2083 |
| Sexual History Taking: Anal, Oral, and Genital (HIV/AIDS) | NYS | - |
| Substance Abuse Screening | HRSA | - |
| Use of Opioid Dependence Pharmacotherapy | NYS | - |
Appendix A
The table below identifies the changes to the Category 1 and Category 2 measures for the MY2022 HIV/AIDS Quality Measure Set.
Category 1 & 2 Measure Changes from 2021 to 2022
| Measure Name | Change | Rationale for Change |
|---|---|---|
| Comprehensive Diabetes Care: Eye Exam (retinal) Performed | Replaced | Measure name and specifications revised by NCQA for 2022 Measure set |
| Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%) | Replaced | Measure name and specifications revised by NCQA for 2022 Measure set |
| Eye Exam for Patients with Diabetes | Added | The measure added by NCQA for HEDIS MY2022 – replaced CDC measure |
| Hemoglobin A1c Control for Patients with Diabetes | Added | The measure added by NCQA for HEDIS MY2022 – replaced CDC measure |
| Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment | Replaced | Measure name and specifications revised by NCQA for 2022 Measure set |
| Initiation and Engagement of Substance Use Disorder Treatment | Added | The measure added by NCQA for HEDIS MY2022 – replaced IET measure. |
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1. HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).1
2. New York State Department of Health, Medicaid Redesign Team, A Path Toward Value-Based Payment: Annual Update, September 2019. (Link) 2
3. HEDIS® Measurement Year 2022 Volume 2 Technical Specification for Heath Plans, General Guidelines section 33.3
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